Shao Ruyu, Shen Faquan, Soleymani Majd Hooman, Qin Xiaoqing, Yao Desheng, Long Ying, Wang He, Wei Yousheng, Chang Xin
Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.
Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom.
Front Surg. 2024 Jul 18;11:1387038. doi: 10.3389/fsurg.2024.1387038. eCollection 2024.
Iatrogenic ureteral injury is a severe surgical complication, with a highest incidence of 1.5% in gynecological surgeries. The purpose of this report is to document our initial experience with using methylene blue (MB) to label the ureter in gynecological laparoscopic surgeries and to explore its effectiveness and safety. This is also a novel description of simultaneously visualizing ureteral MB fluorescence and sentinel lymph nodes (SLN's) Indocyanine Green (ICG) fluorescence using the same camera.
This study included patients undergoing gynecological laparoscopic surgeries, with the same surgeon performing all cases. During the early stages of each surgery, rapid intravenous infusion of MB was administered. For cases requiring SLN imaging, we also injected ICG solution into the cervix. Assessment of the included cases was conducted both intraoperatively and postoperatively. The group that had MB fluorescence (Group A) was compared to a control group that did not have it (Group B).
A total of 25 patients (Group A) received MB during surgery, demonstrating 45 ureters clearly, with an imaging success rate of 90%. Continuous and clearer fluorescence imaging was achieved in cases with ureteral hydronephrosis. In most patients, ureteral fluorescence was visible 15-20 min after intravenous infusion of MB, and 64% still exhibited fluorescence at the end of the surgery. In patients who had both ICG and MB, dual fluorescence imaging was achieved clearly. Among the included cases, there were no iatrogenic ureteral injuries (0%), which we observed to be lower than in patients who did not receive MB (1.3%). The rate of adverse events was similar in both groups.
Using MB fluorescence is an effective and safe method of visualizing the ureters during gynecological surgeries, and can diminish iatrogenic ureteral injury without increased associated adverse events. It therefore may offer promising prospects for clinical application.
医源性输尿管损伤是一种严重的手术并发症，在妇科手术中的发生率最高可达1.5%。本报告的目的是记录我们在妇科腹腔镜手术中使用亚甲蓝（MB）标记输尿管的初步经验，并探讨其有效性和安全性。这也是关于使用同一摄像头同时可视化输尿管MB荧光和前哨淋巴结（SLN）吲哚菁绿（ICG）荧光的新颖描述。
本研究纳入接受妇科腹腔镜手术的患者，所有病例均由同一位外科医生实施。在每台手术的早期阶段，快速静脉输注MB。对于需要进行SLN成像的病例，我们还将ICG溶液注入宫颈。对纳入病例进行术中及术后评估。将有MB荧光的组（A组）与无MB荧光的对照组（B组）进行比较。
共有25例患者（A组）在手术中接受了MB，清晰显示了45条输尿管，成像成功率为90%。输尿管肾积水的病例实现了持续且更清晰的荧光成像。在大多数患者中，静脉输注MB后15 - 20分钟可见输尿管荧光，手术结束时64%的患者仍有荧光。在同时使用ICG和MB的患者中，实现了清晰的双荧光成像。在纳入病例中，未发生医源性输尿管损伤（0%），我们观察到这一比例低于未接受MB的患者（1.3%）。两组不良事件发生率相似。
在妇科手术中使用MB荧光是一种可视化输尿管的有效且安全的方法，可减少医源性输尿管损伤且不增加相关不良事件。因此，它可能具有良好的临床应用前景。
